摘要
目的探讨上尿路结石局麻下二期碎石手术患者术中应用末端可弯负压输尿管软镜治疗效果及无管化离院临床研究。方法选取2023年3月至2024年10月阳春市人民医院82例需采取二期手术的上尿路结石患者作为研究对象,根据不同手术方式及麻醉适应证分为观察组与对照组,每组41例。对照组采取全麻输尿管软镜钬激光碎石术,术后患者留置双J管离院;观察组采取局麻下术中末端可弯曲负压输尿管软镜钬激光碎石治疗及无管化离院。对比两组围手术期指标、术后无石率、血常规指标及术后并发症。结果两组患者手术时间比较,差异无统计学意义(P>0.05);观察组麻醉费用少于对照组,术后排气时间及住院时间均短于对照组,差异有统计学意义(P<0.05)。两组患者结石清除率比较,差异无统计学意义(P>0.05)。术后1d,两组患者白细胞计数(white blood cell count,WBC)、C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)指标较术前降低,但观察组术后1d各项指标均低于对照组,差异有统计学意义(P<0.05)。出院后1个月,观察组并发症总发生率为2.44%,低于对照组的17.07%,差异有统计学意义(P<0.05)。结论采用局麻下末端可弯负压输尿管软镜联合无管化日间手术模式治疗上尿路结石,可显著缩短住院时间、避免全麻及相关费用,降低医疗成本,减少严重感染风险,同时避免留置及二次取出支架管的痛苦与不便,具有良好推广应用价值。
Objective To explore the therapeutic effect of distal flexible negative-pressure ureteroscope and the clinical study of tubeless discharge in patients undergoing second-stage lithotripsy for upper urinary tract stones under local anesthesia.Methods A total of 82 patients with upper urinary tract stones who required second-stage surgery in Yangchun People's Hospital from March 2023 to October 2024 were selected as the research objects.They were divided into the observation group and the control group according to different surgical methods and anesthesia indications,with 41 cases in each group.The control group underwent general anesthesia combined with ureteroscopic holmium laser lithotripsy,and was discharged with an indwelling double-J stent.The observation group received distal flexible negative-pressure ureteroscopic holmium laser lithotripsy under local anesthesia and was discharged without indwelling stents(tubeless discharge).Perioperative indicators,postoperative stone-free rate,blood routine indicators,and postoperative complications were compared between the two groups.Results There was no statistically significant difference in the operation time between the two groups(P>0.05).The anesthesia cost of the observation group was lower than that of the control group.The postoperative exhaust time and hospital stay of the observation group were shorter than those of the control group,with statistically significant differences(P<0.05).There was no statistically significant difference in the stone clearance rate between the two groups(P>O.05).On the first day after operation,the white blood cell count(WBC),C-reactive protein(CRP),and procalcitonin(PCT)of both groups were lower than those before operation,while the indicators of the observation group were lower than those of the control group,with statistically significant differences(P<0.05).One month after discharge,the total incidence of complications in the observation group(2.44%)was lower than that in the control group(17.07%),with a statistically significant difference(P<0.05).Conclusion The application of distal flexible negative-pressure ureteroscope under local anesthesia combined with tubeless day surgery mode in the treatment of upper urinary tract stones can significantly shorten the hospital stay,avoid general anesthesia and related costs,reduce medical expenses,and lower the risk of severe infection.Meanwhile,it avoids the pain and inconvenience caused by indwelling and secondary removal of stents,which has good popularization and application value.
作者
张劲
何灿
黄泰人
王君勇
林华欣
Zhang Jin;He Can;Huang Tairen;Wang Junyong;Lin Huaxin(Department of Urology,Yangchun People's Hospital,Yangjiang,Guangdong 529600,China)
出处
《泌尿外科杂志(电子版)》
2025年第4期15-18,共4页
Journal of Urology for Clinicians(Electronic Version)
关键词
上尿路结石
二期碎石术
末端可弯负压输尿管软镜
无管化离院
Upper urinary tract stones
Second-stage lithotripsy
Distal flexible negative-pressure ureteroscope
Tubeless discharge
